Ankle-brachial blood pressure in elderly men and the risk of stroke: The Honolulu Heart Program

Although low ankle/brachial blood pressure index (ABI) is a marker of gener alized atherosclerosis in the elderly, it has not been identified as a risk factor for stroke. The purpose of this report is to examine the relation b etween ABI and stroke in elderly men. ABI was measured from 1991 to 1993 in 2767 men aged 71 to 93 years in the Honolulu Heart Program without a histo ry of stroke and coronary heart disease. Subjects were followed for 3 to 6 years for fatal and nonfatal thromboembolic and hemorrhagic stroke. During follow-up, there were 91 strokes. There was an age-adjusted 2-fold excess i n men with an ABI < 0.9 (6.0%) versus men with an ABI greater than or equal to 0.9 (2.9%, P < 0.01), Thromboembolic events occurred in 4.6% of men wit h an ABI < 0.9 and in 2.0% in those with an ABI greater than or equal to 0. 9 (P < 0.01). Hemorrhagic stroke was also more frequent in men with a low A BI (< 0.9) versus a higher ABI (1.9 vs. 0.8%, respectively). After adjustin g for other factors, the risk of total and thromboembolic strokes increased with declining ABI (P = 0.019 and P = 0.004, respectively). The relation b etween ABI and stroke was similar and statistically significant in the pres ence and absence of diabetes and hypertension (P < 0.05). Findings suggest that ABI is inversely related to the incidence of stroke. Simple measuremen t of ABI in an outpatient setting could be an important tool for assessing the risk of stroke in the elderly. (C) 2001 Elsevier Science Inc. All right s reserved.